Implementation and assessment of a provincial early palliative care initiative for patients with pancreatic cancer.
Authors: Christina Kim, Ruth Loewen, Paul Joseph Daeninck, Stephanie Lelond
Journal: Journal of Clinical Oncology (2023)

e18742 Background: Early palliative care (EPC) referral reduces health care costs &amp; improves quality of life and survival in some advanced cancers. One barrier to EPC is hesitancy of care providers to refer. In April 2022, our provincial cancer centre (CCMB) implemented a clinical nurse specialist (CNS)-led intervention for patients with advanced pancreatic cancer (PANC), circumventing known barriers. New PANC referrals received at the centralized referral office are triaged by an oncologist &amp; concurrently referred to the CNS. CNS consultation focuses on physical &amp; psychological symptoms, medication review, patient/family coping, &amp; goals of care. Education is provided on PANC diagnosis, prognosis, symptoms, potential treatment options, navigating the cancer system &amp; community palliative care/hospice supports, with close collaboration with the patient’s primary care provider. The primary aim of this study is to assess the impact of the CNS role on referral to multidisciplinary palliative care/hospice services within 8 weeks of diagnosis. Methods: We compared patients with PANC in the pre-implementation period (April 1, 2021 to December 31, 2021) to the post-implementation period (April 1, 2022 to December 31, 2022). Patients were identified using the Manitoba Cancer Registry &amp; the CNS clinical database. Descriptive statistics were used to report quality measures. A one sample test of proportions was used to compare EPC referral in the pre- &amp; post-implementation periods. Results: In the pre-implementation period, 64 patients were referred to CCMB with PANC. Fifty-nine (92%) were diagnosed via biopsy, 52 (81%) had consultation with a medical oncologist, 32 (50%) received chemotherapy. Forty-four (69%) were referred to a palliative care/hospice program. In the post implementation period, 88 patients were referred to CCMB. Eighty-five (97%) accepted a consultation with the CNS, with a median time to meeting of 6 days (range, 0-18), and 75% of patients seen within 10 days. After CNS consultation, 28 (32%) declined biopsy, oncology appointment or both. Overall, sixty-three (72%) patients in this cohort had a diagnostic biopsy, 59 (67%) had a consultation with a medical oncologist, 29 (33%) received chemotherapy. Fifty-nine (67%) were referred to a palliative care/hospice program. In the pre-implementation period, 24 (38%) patients were referred to palliative care/hospice within 8 weeks of diagnosis, compared to 44 (50%) in the post-implementation period (p = 0.0154). Conclusions: This novel approach demonstrates CNS assessment &amp; education soon after diagnosis of PANC, at the time of referral to CCMB, results in an increased proportion of patients being referred for community-based palliative care/hospice within 8 weeks of diagnosis. Exploring patient goals early may also spare patients from invasive &amp; timely procedures, allowing those with a life limiting illness to focus on quality of life.